Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 95007032 | CA |
NPI | 1003330440 |
---|---|
Provider Name | Tamara Carpenter |
First Address | Fresno, CA 93721-1431 |
Second Address | Fresno, CA 93721-1324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2017 |
Last Update Date | 27/01/2021 |